INSURANCE CONNECTION continued
PDA Question : Are these requirements universal for all providers or are the requirements for general dentists different than for specialists ?
Cigna : Cigna ’ s requirements apply to both general dentist and specialist dentists .
Delta Dental : These requirements are universal for all participating providers .
Dominion Dental : Requirements for clinical necessity of S / RP are universal for all providers regardless of whether they are general dentists or specialists , in network or out of network .
UCCI : The requirements apply to all providers except periodontists . S / RP submitted from periodontists is not reviewed on a prepayment basis .
PDA Question : Are these requirements universal for participating and non-participating providers ( general dentists and specialists )?
Cigna : These requirements apply to all dentists .
Delta Dental : The qualifying clinical conditions , frequency limitations and procedure conflict rules applied during benefit determination are the same for both participating and non-participating dentists .
Dominion Dental : Requirements for clinical necessity of S / RP are universal for all providers regardless of whether they are general dentists or specialists , in network or out of network .
UCCI : Yes , the requirements apply to both participating and non-participating providers .
PDA Question : Are they any limitations of the number of teeth or quadrants that can be treated during one day ?
Cigna : There are no limitations on the number of teeth or quadrants that can be treated during any one day . Cigna does reserve the right to request additional information on a case by case basis , including documentation when more than two quadrants are treated in one day .
Delta Dental : Delta Dental does not currently impose limitations in the number of teeth or quadrants that can be treated during any one day . Treatment times for periodontal class II patients with 4-6 millimeter pocket depths , bleeding on probing and detectable subgingival calculus deposits require a minimum of 30 to 45 minutes per quadrant , dependent on the numbers of affected teeth in the quadrant . Additionally , periodontal scaling and root planing often requires administration of local anesthesia injections . These factors would be considered in determining the appropriate treatment sequence .
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